Provider Demographics
NPI:1033925789
Name:HOLISTIC DEVELOPMENTAL PEDS & INTEGRATIVE MED, PLLC
Entity type:Organization
Organization Name:HOLISTIC DEVELOPMENTAL PEDS & INTEGRATIVE MED, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:PENKAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-867-2343
Mailing Address - Street 1:4940 BROADWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5732
Mailing Address - Country:US
Mailing Address - Phone:210-403-2343
Mailing Address - Fax:210-403-2350
Practice Address - Street 1:4940 BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5732
Practice Address - Country:US
Practice Address - Phone:210-403-2343
Practice Address - Fax:210-403-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-07
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty